HPV Vaccination Program in England Effectively Reduces Cervical Disease in All Socioeconomic Groups

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HPV is one of the most common sexually transmitted infections, but routine vaccination of young people, which began in England in 2008, can protect them against strains that cause cancer in later life. Using NHS England cancer data for vaccinated and unvaccinated women aged 20-64 from January 2006, this new study examined whether the high HPV vaccination effectiveness already seen up to July 2019 continued in an additional year of follow-up, to June 2020. Results showed that in the group offered vaccination at age 12-13, rates of cervical cancer and grade 3 precancerous cervical lesions (CIN3) in the additional year of follow-up were 84% and 94% lower, respectively, than in the older unvaccinated group. The researchers estimate that by mid-2020, HPV vaccination had prevented 687 cancers and 23,192 CIN3s.

Because cervical cancer rates have always been higher in the most deprived groups there have been concerns that HPV vaccination could benefit those at greatest risk of cervical cancer the least. To address this, the study used the index of multiple deprivation, which divides local areas into five equal groups, from the most to the least deprived, to assess the effect of the vaccination programme by social and economic deprivation. The highest rates remained among women living in the most deprived areas, but the HPV vaccination programme had a large effect in all five levels of deprivation. The greatest numbers of cervical cancer cases were prevented in women in the most deprived areas and the fewest in women in the least deprived fifth. The number of women with CIN3 prevented was also high across all deprivation groups but greatest among women living in the more deprived areas. For cervical cancer, the strong downward gradient from high to low deprivation seen in the older unvaccinated cohort was no longer present among those offered the vaccine.

Authors note that the observational study was based on high-quality population-based cancer registry data, making it less prone to biases from unobserved confounders than an analysis based on individual-level data on HPV vaccination status.

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Lead author, WIPH Professor Peter Sasieni, said: 'Our research highlights the power of HPV vaccination to benefit people across all social groups. Historically, cervical cancer has had greater health inequalities than almost any other cancer, but this study captures the huge success of the school-based vaccination programme in helping to close these gaps and reach people from even the most deprived communities. In the UK, the elimination of cervical cancer as a public health problem in our lifetime is possible with continued action to improve access to vaccination and screening for all.'

Reference: Falcaro M, Soldan K, Ndlela B, Sasieni P. Effect of the HPV vaccination program on incidence of cervical cancer and grade 3 cervical intraepithelial neoplasia by socioeconomic deprivation in England: population based observational study. BMJ. 2024;385:e077341. doi: 10.1136/bmj-2023-077341

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